Summary of the day

I did attend rounds today and it was a really good experience. I feel much better about how Scott is doing and had my questions answered.

Here's a summary of the day, including what I learned in rounds:

The medical team was pleased with Scott's CT scan results, last night. They did want to do further testing and do a CT scan of his legs to ensure their was nothing concerning with them (blood clots, infection). The surgeon who did Scott's amputation evaluated Scott this morning and looked closely at his wound. He felt 100% confident that he had removed all the infection in Scott's leg and that Scott's current infection was not in his amputated leg. This is great news.

They also wanted to do another CT scan of his abdomen and one of his pelvis. He had all of these done about an hour ago and we don't know any results yet.

They believe that Scott's confusion (delirium) was brought on by infection (we'll get to that in a bit) and by sleep deprivation. It came on very acutely (that evening he was joking and visiting with us and by night he didn't know where he was).

Scott has a UTI (Urinary Tract Infection) and is being treated with antibiotics. They believe that the UTI is a contributor but not the only offender...and an infection somewhere else is brewing, but they are not sure yet.

They wanted to do a lumbar puncture (AKA Spinal Tap) to get a sample of Scott's spinal fluid to rule out meningitis. Unfortunately, they would need to roll Scott on his abdomen to get the sample and he couldn't be moved like that today. I'm not sure when or if they still plan on doing this test.

A bit of background...when Scott was admitted (two weeks ago tomorrow) his WBC (white blood cell) count was normal. This is completely shocking for what a terrible infection Scott had. It should have been very elevated to show that Scott's immune system was kicking in to fight off the first infection.

Currently his WBC count is normal (4.2), although he again has an infection. The doctors think that Scott's immune system is not quite working like it should. They are not trusting/relying on his lab results (at least the WBC count) to determine infection.

Scott's labs did show that he had a very low hematocrit (19.9) and hemoglobin (6.8), because of this he needed to have a blood transfusion and he received two units this morning. His platelets were also lower than I have seen them since his admission (they were 40-Scott's have been between 50-60 and normal is above 150).

He continues to have low sodium, which they are calling a "chronic problem." His sodium today was 127. His magnesium level was also low (1.7) and he received IV replacement of magnesium today as well.

They have not checked another ammonia level today and the doctors do not believe that Scott's confusion is related to his liver.

They also started the diuretic again (Lasix) to try and rid Scott of the extra fluid. Again his fluid intake is far exceeding his output and he is very swollen again. His hands look like puffy marshmallows.

Scott also had a NG tube placed (a tube down the nose- to give meds, suck fluid out of the belly, etc). I pray, pray, pray that they will be able to take this out before they wake Scott up, because he is going to hate that(who wouldn't?).

They talked in rounds today about placing a feeding tube and starting to feed Scott, but it has happened yet. The nutritionist came and talked to me about what Scott liked to eat, how his appetite usually is, etc. I told him he is a "meat and potatoes" kind of guy but somehow I don't believe that will be in his feeding tube. :)

Scott still has the breathing tube and their is no definite time frame for when they will try to extubate (take it out) him. The medication he is currently on to keep him sedated is not the best to allow Scott to reach a deep sleep (REM). They want to change him to a different medication to sedate him as well as allow him to be in a deep sleep.

He continues to do the work (breathing) on his own, although he did need a little assist when they were moving him around to do the CT scan.

They are also watching Scott's skin closely and changing his position frequently. Again, pray that Scott's skin can heal and not have any further insult. The last thing he needs is a bed sore.

Here is the plan:

Besides the UTI they are still looking for another source of infection. The honest truth though is, that we many never really know. Again, he is on three different antibiotics and it should cover any bugs.

They will keep him sedated and intubated at least for the night and see what tomorrow brings.

They will continue the antibiotics, while we wait to see if the infection manifests itself.

He does appear to be resting but he is moving his arms and head more tonight than he was this morning.